From bone to titanium: Man undergoes rare procedure

Sunday

Nov 30, 2008 at 12:01 AMNov 30, 2008 at 12:38 PM

Gene Johnson underwent five hip surgeries, including four in a six-month span, on his right leg. Even after the seemingly never-ending cycle of surgeries and rehabilitation, the 81-year-old man's family was unprepared for what came next.

Ryan Ori

Gene Johnson underwent five hip surgeries, including four in a six-month span, on his right leg.

Even after the seemingly never-ending cycle of surgeries and rehabilitation, the 81-year-old Princeton, Ill., man's family was unprepared for what came next.

"I think we were all in a state of shock that they were going to do this," said his wife, Lois. "I'd never heard of such a thing. Everybody kind of had their mouth open."

There was a reason Johnson and his family were unfamiliar with the OSS Orthopaedic Salvage System. The procedure, which replaces the entire femur (thigh bone), hip and knee with titanium pieces, is believed to be performed fewer than 100 times annually in the United States.

Dr. Henry Finn, chief of orthopedic surgery at Weiss Memorial Hospital and medical director of the University of Chicago Bone and Joint Replacement Center at Weiss, invented the system that is most typically used in younger cancer patients. Finn is also a professor of surgery at the University of Chicago.

Finn and another orthopedic surgeon at Weiss, Dr. Kris Alden, did the five-hour surgery Oct. 8 in Chicago.

Describing the system, Finn compared it to a high-tech version of children playing with Tinkertoys.

"This system that we used on Mr. Johnson is something that can be picked off the shelf, the knee joint, the hip joint and then all the parts in between, and you custom build it with connections and mechanical tapers that are borrowed from the tool-and-dye industry and screws that lock these pieces together that were borrowed from the aviation industry," Finn said. "They actually strip and lock when you tighten them down, so they don't vibrate loose."

The rare option was a last resort after traditional leg surgeries failed to keep Johnson, a former football player at Knox College, on his feet.

Johnson had successful hip-replacement surgery on his left leg in 1995, which has caused no complications.

A botched replacement on the right side in 1998 created a series of follow-up surgeries. Three times in 2008, Johnson had revisional surgery only to rebreak the brittle femur.

His right leg filled with screws, wires and metal plates, Johnson faced the possibility of amputation. Finn handed Johnson a pamphlet detailing how the titanium femur functions.

"It scared the heck out of me, even the thought," Johnson said. "But I was down to very few choices. They could have cut the leg off and left me with a wheelchair or in bed for the rest of my life, or get this done. So that's what we did."

Johnson, a retired salesman and executive with Homeway Homes, spent three weeks in Chicago after surgery. After three weeks of rehab work there, he now does exercises at home in Princeton with a physical therapist who visits three times per week.

It will take months, and maybe even a year or more, to move efficiently on the new leg. After a series of visits to Chicago short-term, Johnson eventually will make once-a-year checkup visits to Weiss.

Some muscles are unable to attach to the artificial femur, and others are looped through ends of the femur. Until the surrounding muscles have time to strengthen, Johnson must wear a brace to prevent his knee from moving side-to-side, rather than forward and back.

Unable to even lift his leg when he first arrived home, Johnson now is able to get around slowly with the use of a walker. He still needs help swinging the leg into bed but remains hopeful.

"I don't know how he did it," Lois Johnson said. "He was so determined that he was willing to go through the next surgery and the next surgery and the next surgery.

"Determination - he just has it. Always has. He's a good Irishman."

She also laughed when recounting phone calls her husband received from other people considering a partial or full femur replacement.

"We call him Dr. Johnson," she said.

As technology improves to address possible longevity issues with the titanium pieces, Finn expects to see full and partial femur replacements become more common among non-cancer patients in the future.

"If you do this in a 30-year-old, these are metal and plastic parts that won't last forever," Finn said. "Eventually, they will break down and need repair. Eventually, you might have a complication and you might lose your limb.

"Mr. Johnson was in a position where it was either lose the limb, live in pain or do this. So that's an easy decision, when you think about it."

Johnson's goal is to become independent enough to enjoy activities with his three children, four grandchildren and four great-grandchildren.

A longtime St. Louis Cardinals season-ticket holder and ardent follower of Bureau Valley High School sports, the Walnut, Ill., native eagerly awaits a return to the bleachers.

"Well, (the family) decided if I was going to have any kind of a life, I'd better do this," Johnson said. "I'm glad I did it. It's like a new shot at life."

Ryan Ori can be reached at 686-3264 or rori@pjstar.com.

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